methimazole and Blood-Loss--Surgical

Preoperative preparation of the patient with Graves' disease (GD) is crucial to avoid intraoperative or postoperative complications associated with anesthesia or surgery. We aimed to evaluate thyroid blood flow and microvessel density in patients with GD according to antithyroid drug (ATD) treatment, preoperatively.. Forty-three patients were divided into two groups according to the ATD type. Patients in group 1 (n = 25) were treated with methimazole, whereas patients in group 2 (n = 18) were treated with propylthiouracil, preoperatively. Blood flow through the thyroid arteries was measured by color flow Doppler ultrasonography. The microvessel density (MVD) was assessed immunohistochemically and via Western blot analysis using the level of CD-34expression in thyroid tissue.. There was a positive correlation between blood loss and thyroid volume (r(s) = 0.953, P = .0001) and blood flow (r(s) = 0.720, P = .0001) and CD-34 expression (r(s) = 0.331, P = .03) and MVD (r(s) = 0.442, P = .003). No correlation was observed between ATD type and thyroid vascularity. In patients with longer treatment duration before operation, thyroid vascularity was significantly lower relative to patients with shorter treatment durations. According to logistic regression analysis, longer treatment duration had a 142-fold decreased rate of intraoperative blood loss independent of ATD type.. Preoperative ATD treatment duration may predict intraoperative blood loss during thyroidectomy. Longer treatment duration might be useful in reducing intraoperative bleeding, allowing better visualization and preservation of the nerves and parathyroid glands.

Topics: Adolescent; Adult; Antithyroid Agents; Blood Flow Velocity; Blood Loss, Surgical; Female; Graves Disease; Humans; Male; Methimazole; Microcirculation; Middle Aged; Preoperative Care; Propylthiouracil; Reference Values; Thyroid Gland; Thyroidectomy; Ultrasonography, Doppler, Color

The aim of this study was to ascertain the utility of echo-Doppler in the analysis of the low resistance thyroid vascularization in diffuse toxic goiter (DTG), and the effectiveness of Lugol's solution (iodine-iodide solution) in patients undergoing thyroidectomy.. Twenty-five patients with diffuse toxic goiter were evaluated and compared with 19 normal subjects. Patients were treated with increasing doses of Lugol's solution 2% for 7 days until a total dose of 75 mg of iodine was given. Echo-Doppler was performed on the last day of treatment, 12 hours before operation.. Mean basal Doppler Resistance Index (RI) of intrathyroid arterial flow was significantly lower in patients with DTG compared with normal controls (0.4718 +/- 0.0625 versus 0.55 +/- 0.05, range: 0.472 to 0.643; p = 0.008). Moreover, the RI was significantly increased in patients with DTG after Lugol's solution (+16.46 +/- 10.22%, range: -2.59 to +39.97; p< 0.0005).. Echo-Doppler RI allowed documenting lower arterial resistances within the thyroid gland in patients with DTG. The use of preoperative Lugol's solution therapy induces normalization of those changes for safer thyroidectomy.

Topics: Adult; Antithyroid Agents; Arteries; Blood Loss, Surgical; Case-Control Studies; Combined Modality Therapy; Drug Monitoring; Female; Graves Disease; Hemostatics; Humans; Iodides; Male; Methimazole; Middle Aged; Preoperative Care; Thyroid Function Tests; Thyroid Gland; Thyroidectomy; Ultrasonography, Doppler; Vascular Resistance